TKR Crunching & Thunking

[kneeper]

^totally agree.

 

[Julia1911]

Well, had my TKR on 1/27. Lots of progress between weeks 3 and 4, but now starting week 4, have had set-backs and lots of pain overnight. And swelling.

Sleep to about 4 or 5 am before waking, but then get up at least 2 more times until the morning. Try to stay in bed between 6 and 8 am, but lots of pain in between fitful sleep. Keep rolling on my sides (I was a side sleeper), but this hurts, even with pillows between the knees.

Did 120 revolutions on elliptical (in 3 sets morning, noon, late afternoon) yesterday. May be the cause of the stiffness, but requires so much less ROM than the stationary bike (which I cannot do yet). But that is only 40 turns of the machine each time. Still lots of icing.

Down to only 1 nap a day for the past few days, which is good.

But developed UTI yesterday, which has made me tired and discouraged. Years and years since I have had one.

And lots of clicking and thunking of implant now. Pain under kneecap and where thigh and calf bone were cut. Guess that is the bone/nerves healing.

Too late to turn back now! Ha ha.

 

[Celle]

Did 120 revolutions on elliptical (in 3 sets morning, noon, late afternoon) yesterday. May be the cause of the stiffness, but requires so much less ROM than the stationary bike (which I cannot do yet). But that is only 40 turns of the machine each time. Still lots of icing.

Go easy on the exercises - overdoing can certainly contribute to stiffness. Once a day is plenty.
Don't forget that every time you walk, you are exercising your knee, and walking is the best exercise of all.

 

[offwhite]

Well, had my TKR on 1/27. Lots of progress between weeks 3 and 4, but now starting week 4, have had set-backs and lots of pain overnight. And swelling.

Sleep to about 4 or 5 am before waking, but then get up at least 2 more times until the morning. Try to stay in bed between 6 and 8 am, but lots of pain in between fitful sleep. Keep rolling on my sides (I was a side sleeper), but this hurts, even with pillows between the knees.

Did 120 revolutions on elliptical (in 3 sets morning, noon, late afternoon) yesterday. May be the cause of the stiffness, but requires so much less ROM than the stationary bike (which I cannot do yet). But that is only 40 turns of the machine each time. Still lots of icing.

Down to only 1 nap a day for the past few days, which is good.

But developed UTI yesterday, which has made me tired and discouraged. Years and years since I have had one.

And lots of clicking and thunking of implant now. Pain under kneecap and where thigh and calf bone were cut. Guess that is the bone/nerves healing.

Too late to turn back now! Ha ha.

Hi J, my mom had the revision surgery on the same day as you did yours. Her situation is almost exactly as your. Her bending was 103 right after the surgery, and then decrease to 83 in 4 days, now her bending stays on 83 for about 4 weeks. There is only improvement when she goes to PT, and then lost it in the next few days. How's your bending now? has your stiffness slowly improvement?

 

[Julia1911]

Well, had my TKR on 1/27. Lots of progress between weeks 3 and 4, but now starting week 4, have had set-backs and lots of pain overnight. And swelling.

Sleep to about 4 or 5 am before waking, but then get up at least 2 more times until the morning. Try to stay in bed between 6 and 8 am, but lots of pain in between fitful sleep. Keep rolling on my sides (I was a side sleeper), but this hurts, even with pillows between the knees.

Did 120 revolutions on elliptical (in 3 sets morning, noon, late afternoon) yesterday. May be the cause of the stiffness, but requires so much less ROM than the stationary bike (which I cannot do yet). But that is only 40 turns of the machine each time. Still lots of icing.

Down to only 1 nap a day for the past few days, which is good.

But developed UTI yesterday, which has made me tired and discouraged. Years and years since I have had one.

And lots of clicking and thunking of implant now. Pain under kneecap and where thigh and calf bone were cut. Guess that is the bone/nerves healing.

Too late to turn back now! Ha ha.

Hi J, my mom had the revision surgery on the same day as you did yours. Her situation is almost exactly as your. Her bending was 103 right after the surgery, and then decrease to 83 in 4 days, now her bending stays on 83 for about 4 weeks. There is only improvement when she goes to PT, and then lost it in the next few days. How's your bending now? has your stiffness slowly improvement?

New PT yesterday told me I had 90 degrees ROM and I am exactly "on track" where I should be 1 month out, but with ROM and healing. That helped.

She was very gentle, the exercises were uncomfortable (well, the flat table heel slides did hurt as they always do, but only did 2 slow sets of 10).

Did some partial rotations on the stationary bicycle went up as far as could, then stretch and hold--then back again the other way, stretch and hold for 20 to 30 seconds, uncomfortable, but doable. She felt I would soon be able to do an entire rotation either next time, or if she put the seat up a little.

Did some achilles tendon/hamstring stretches--again not to pain but discomfort, stretch and hold for at least 10 seconds. Also, heel raises to get fluid out of joint.

She feels stretching and holding for up to 30 seconds is the way to go and whole session was good, except I did miss the deep tissue message from the other PT. PT says now the slow stretch and hold will increase the ROM gradually. It is the holding that will eventually increase ROM.

However, I always have a rough evening/night after PT. Mostly let the joint rest the next day, except for a little gentle stretching/walking around the house.

The 2 inch long deep crater at the top of my incision has almost healed over the past 2 weeks. The inch or so crater over the top of the knee cap has gotten less deep but still wants to separate, so am still using 1/2 inch by 2 inch steri-strips over those parts of incision.

Did not use OxyCod last night but have switched to extra strength Tylenol along with 2 Alleve/naproxen 3x a day. Long night, but again, ususal after PT session even with Oxy.

Continue to ice and elevate.

I know I am getting better gradually, just tired after a full month of almost constant, although varying, pain. New PT also advised getting right knee done before it becomes as debilitated as left one was so recovery will be easier. Still, can't face that for at least a year in my current mental state. Maybe if I can get to full day/full night without pain (or just twinges) it will help.

Everyone here has been so wonderful. Keeps me going.

 

[Qdogpa]

Here is hoping anyone of us in need of a great night sleep , gets one! My recovery is very similar to yours, including pain, etc... TIOF...

 

[Jockette]

Long night, but again, ususal after PT session even with Oxy.

This is proof you are doing too much in PT. 20 heel slides is too many to be done so close together. In fact, they aren’t essential, just walking around doing your daily activities will encourage your ROM to improve.

It is the holding that will eventually increase ROM.

I also think a 30 second hold is too long.

New PT also advised getting right knee done before it becomes as debilitated as left one was so recovery will be easier.

This will not guarantee “an easier recovery.” Every knee is unique and the recovery will vary. My knee was not that bad at all, I now realize, and the recovery from my Patellofemoral partial has been way worse than many of our members who had totals. Do your next one when you are ready, not necessarily when someone else tells you that you are ready.

 

[Julia1911]

Years ago, after I had a hemorrhoid banded, the lady doc told me to use Miralax (or generics). I asked if it was habit forming and she said no, and I could use it everyday if I needed. Put it in my coffee or tea in the morning after I got home from the hospital.

Did use it this time (like it so much better than the stool softener which seemed to cause more problems than it helped), but still got a few small tears. Trying to heal them with diaper rash ointment now. Doc said no new 'roids though.

 

[Julia1911]

Well, good and bad this week.

Finally got a few "backward" rotations on exercise bike at PT. Rest of day/night felt pretty good, but next day very sore again. PT told me to take it easy next day after that.

Having lots of heart palpitations since 5 days after surgery. After many halter monitors, doc says mostly PACs and PVCs (premature atrial and ventricular contractions). Nothing that can be done, but still unnerving when your heart skips beats. Have not had many for over a year since my autoimmune pericarditis cleared up 2018. Just looked up on google if Naproxen/Alleve can cause and it said all NSAIDs can cause.

Also remembered that I used to only take Alleve in the morning because it caused me sleeplessness. Used Advil later in the day/at night. It does not interfere with my sleep. Switching to extra strength Tylenol afternoon and night too; Alleve in morning and after noon time PT.

Not sure it really does much, but slept a little better last night. Woke up every 2 hours but was able to get back to sleep most of the time. Also sleeping a bit on my right side now, which also helps. Prefer the left, but won't work with left TKR yet. Put pillow under left leg and straighten and able to sleep for a while in that position.

Pain not constant thru-out day so that is starting to help mood. Hope improvement continues, but will be realistic. Know I still have a long way to go.

 

[Julia1911]

Well, 5 weeks as of this last Monday, Mar 2 (surgery 1/27/20).

This week I could actually rotate on stationary bicycle backwards (1st), then suddenly forward. ROM went from about 94 to 110 in space of 2 days (2 PT sessions a day apart). Still get clunky and stiff, but much, much better. Funny, when I start on the bike, PT just has me stretch forward and hold, stretch backwards and hold. Hurts at first (not real bad) then suddenly, after a few minutes, you can go forward or backward with ease and little to no pain.

Now my (second) biggest obstacle is my stir-crazyness and over-doing. Had hubby along Sunday in car to see if I could drive yet? I could! Lucky it was my left leg. When I get the right one done, I know I'll be out of commission for at least 3 months. Now I'm out trying to stock up on Corolla Virus supplies (in the US) if it hits here. Knee lets me know when I overdue or am on it for too long. Still icing/elevating.

Have only been using Alleve or Advil 2 to 3 times a day and Tylenol X-strength 2-3 times a day for over a week now.

BIGGEST problem. I still can hardly sleep. Really can't sleep in my bed anymore on my back. Just lie there for hours. Maybe get 5 - 6 hours in snatches of 1 1/2 to 2 1/2 hours at a time over the course of a night. Lie in bed 2 hours, get frustrated, lie in recliner (not a "sleep-type" recliner, more a TV watching, slanted-back feet up type). Get stiff in it, but the only way I can doze off. Stopped taking naps almost 2 weeks ago.

Trying dark room, turning off TV, etc., even Benedryl -- nothing helps no matter how tired.

But so happy for progress.

 

[Jockette]

Here’s an article about post op sleep:

Sleep deprivation is pretty much inevitable - but what causes it?

Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...

bonesmart.org

I was a side sleeper before surgery and what helped me sleep on my back was elevating my legs the whole time. It took the pressure off my lower back. I came to like it so much that I still sleep that way, 3 years later! Who knew!

 

[Julia1911]

I meant Corona virus (LOL). Must have been a senior moment thinking abour a car. Duh.

Maybe it is the sleep deprivation.

 

[Julia1911]

At 7 weeks as of Monday, March 16, I still cannot sleep more than 3 hours at a time and then knee stiffness and soreness wakes me up. Can sleep some in bed, then in recliner, then back to bed.

Knee felt better during week 6. Pain/stiffness day after PT (2xweek), but then much looser, easier to do at home exercises and felt like making progress. Maybe the even # weeks are better.

Had to cancel PT this week and for remaining 6 or 7 Medicare approved appointments due to our state mostly shutting down due to Corona virus and us geezers being told to shelter in place. PT facility (very diligent about cleaning/wiping down everything constantly) may still have been open, but having had pneumonnia and landing in hospital for a week with that 2 years ago (even with 2 separate pneumonnia vaccines) and heart complications, just too scared to go out at my age anymore. Took months to really recover. Sad because PT person was great and fun.

Trying to do about 20 minutes of exercises a day on my own -- Quad stretches to increase ROM (still not increasing very quickly), achilles/hamstring stretches, toe raises -- all taking about 8 minutes and then 2 minutes on elliptical machine (which is very gentle) and 10 minutes on stationary bicycle. Have gone down 1 notch from maximum length (I'm only 5'2") and it still can be a struggle, but gets a little easier by 7 minutes out. Less crunchy/stiff than when I start. Not trying for speed or records here -- just flexibility.

Finally took the last steri-strip off the kneecap area that kept trying to separate. It is a little depressed in the middle of the scar, but healing and not obviously separating anymore. The top 2 inches where that also happened healed about 2 weeks ago, but is ugly, purple and has spread more than other areas of the scar. Tried to use silicone strip on scar last night to help improve the looks, but it just got too itchy/irritated. Will try bio oil for about a week and see if that helps.

Some pain and burning where steel implant put in above the kneecap and lots of burning/soreness at lower left calf bone area below kneecap. Don't know if too much exercising or just a healing phase.

Tomorrow will only do elliptical to gently stretch and give it a day off of all exercises otherwise. Still icing and elevating. Take 2 Advil 3 x a day and 2 X-strength Tylenol 2 x a day. No more heart palpitations since stopped Alleve 2 weeks ago. Advil doesn't seem to cause that with me.

 

[sistersinhim]

Some pain and burning where steel implant put in above the kneecap and lots of burning/soreness at lower left calf bone area below kneecap. Don't know if too much exercising or just a healing phase.

These are common complaints. You can try icing those areas, too. I believe it's a combo of exercising and healing.

 

[Julia1911]

OK, I was 7 months out yesterday.

Knee not perfect, but hurts less than the unoperated one. Much less pain than before knee surgery (but not the 80% less I was promised), but still healing. Still needs icing and elevation for pain after 3x weekly exercise. Stiff and achy after a long period on feet. Can't use NSAIDs anymore because developed heart arrythmia on them.

Biggest problem: Knee crunches and thunks when bending, moving around while sitting, going up the stairs, etc. No, this is NO "click." It is a "bone-crunching" feeling from the inside of the surgery knee felt up thru the thigh bone to the hip.

Have not been back to the doctor since 2 week post-op (3 month appt. was when we were in severe lock-down for Covid) and still leery (we still have medium level Covid cases). But is/can he really do anything about this??? X-rays at 2 weeks showed "everything lining up."

Had heard from the 1st doctor's forum that the "thunking" would go away eventually when I was only 3 or 4 months out. But is it normal to still be a problem 7 months out?

I had a lot of erosion on the back of the kneecap and a plastic disc had to be put on it. Is this what is crunching/thunking? Will it ever go away? Is a revision possible (it is really annoying and lets me know I have a fake knee almost whenever I move).

This doc was supposed to have the fewest complications and be one of the best around. Now I wonder if I should have gone with the customized implant.

Any thoughts or will I have a crunch/thunk knee the rest of my life (25-30 years)? How to avoid on the second knee?

 

[Julia1911]

Oh, forgot, but I do have almost 100% of my ROM back.

 

[Celle]

Hi @Julia1911
You'll notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread.
If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
Tagging other members and answering tags

Here are the instructions on finding your thread, How can I find my threads and posts?Many members bookmark their thread, so they can find it when they log on. Please do that.

 

[Celle]

Now, about that crunching and clunking - it happens because, instead of the relatively softer bone and cartilage, you now have hard metal and plastic parts moving over each other.
This article explains: Clicking/clunking knee joint after surgery

As long as it isn't painful, it's normal.

My right knee continued to clunk for about 3 years post-op, then it gradually faded away.

Although it's been 7 months since your surgery, your knee hasn't finished healing yet. Complete healing of all your tissues takes a full year, sometimes even a bit longer. Your knee isn't the finished article yet. It's doing well, but it's still a work in progress. Where it is now is not where it will end up.

Try to get an appointment for your surgeon to examine your knee, even if it's only by teleconference. If nothing else, that will help to reassure you.
But unless there is something demonstrably wrong, you aren't going to get a revision because your knee makes a noise, annoying as it is.

Still needs icing and elevation for pain after 3x weekly exercise. Stiff and achy after a long period on feet.

That's normal for only 7 months into a 12-month recovery.

You're still going to PT at 7 months? If you are, I suggest you stop. It isn't necessary any more, since you have almost 100% ROM. And those 3 times weekly sessions may be responsible for some of the knee swelling and irritation.

You don't have to keep doing exercises now. Your normal Activities of Daily Living (ADLs) will be sufficient to keep your ROM moving along.

I know it must feel as if you've been recovering for ever, but I think you still need to make allowances for your new knee, instead of expecting 12-month performance from a 7-month knee.

 

[sistersinhim]

My knee still clunks with certain movements. I can feel it bump a little but doesn't hurt at all.

 

[Julia1911]

Now, about that crunching and clunking - it happens because, instead of the relatively softer bone and cartilage, you now have hard metal and plastic parts moving over each other.
This article explains: Clicking/clunking knee joint after surgery

As long as it isn't painful, it's normal.

My right knee continued to clunk for about 3 years post-op, then it gradually faded away.

Although it's been 7 months since your surgery, your knee hasn't finished healing yet. Complete healing of all your tissues takes a full year, sometimes even a bit longer. Your knee isn't the finished article yet. It's doing well, but it's still a work in progress. Where it is now is not where it will end up.

Try to get an appointment for your surgeon to examine your knee, even if it's only by teleconference. If nothing else, that will help to reassure you.
But unless there is something demonstrably wrong, you aren't going to get a revision because your knee makes a noise, annoying as it is.

Still needs icing and elevation for pain after 3x weekly exercise. Stiff and achy after a long period on feet.

That's normal for only 7 months into a 12-month recovery.

You're still going to PT at 7 months? If you are, I suggest you stop. It isn't necessary any more, since you have almost 100% ROM. And those 3 times weekly sessions may be responsible for some of the knee swelling and irritation.

You don't have to keep doing exercises now. Your normal Activities of Daily Living (ADLs) will be sufficient to keep your ROM moving along.

I know it must feel as if you've been recovering for ever, but I think you still need to make allowances for your new knee, instead of expecting 12-month performance from a 7-month knee.

Reply:
Haven't had PT since 3/13 due to Covid shut-down.

Can I NEVER do aerobic or strenghtening exercise for body health and fitness again after knee surgery? Only just walking around the house and doing light chores? Do I have to wait an ENTIRE year to do moderate exercise? I'm 68 and need some exercise so I don't lose all tone, strength and balance or I'll be in a wheechair and/or fall by time I'm 75 -- especially since I need to go thru this for the other knee in the next year or so. If it wasn't for the plague we'd be out sightseeing or visiting museums, etc.

I built up to this gradually between month 3 and month 7--not all at once: I exercise (maybe) 3 times per week: 10 minutes on elliptical-moderate speed; 10 minutes on (dual action--handles you also push) exercise bike-medium speed; 10 minutes walking on treadmill (medium speed). 2 sets of 10 squats; 5 step-ups each leg; 1 set of 10 toe raises and achilles stretch; 2 sets of 20 ab/adducter side leg raises. Hardly a strenuous workout and lots of recovery time in-between.

And if my knee feels tender, I only do 2 x a week or skip an extra day in between.

I get the "click." This is a crunch and thunk I feel all the way from my knee to my hip bone. Makes almost every movement bad. Really wish I had investigated the custom implant more.